Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline

Abstract Background The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%–94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients...

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Published in:	Surgery for obesity and related diseases Vol. 13; no. 7; pp. 1095 - 1109
Main Authors:	de Raaff, C.A.L, Gorter-Stam, M.A.W, de Vries, N, Sinha, A.C, Bonjer, H.J, Chung, F, Coblijn, U.K, Dahan, A, van den Helder, R.S, Hilgevoord, A.A.J, Hillman, D.R, Margarson, M.P, Mattar, S.G, Mulier, J.P, Ravesloot, M.J.L, Reiber, B.M.M, van Rijswijk, A, Singh, Preet Mohinder, Steenhuis, R, Tenhagen, M, Vanderveken, O.M, Verbraecken, J, White, D.P, van der Wielen, N, van Wagensveld, B.A
Format:	Journal Article Conference Proceeding
Language:	English
Published:	United States Elsevier Inc 01-07-2017
Subjects:	Aftercare - methods Anesthesia Anesthesia - methods Bariatric surgery Bariatric Surgery - methods Consensus guideline Continuous positive airway pressure Continuous Positive Airway Pressure - methods Gastroenterology and Hepatology Humans Obesity, Morbid - complications Obesity, Morbid - surgery Obstructive sleep apnea Perioperative Care - methods Postoperative monitoring Risk Assessment - methods Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - therapy Surgery Postoperative monitoring Anesthesia Continuous positive airway pressure Obstructive sleep apnea Bariatric surgery Consensus guideline
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Summary:	Abstract Background The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%–94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established. Objectives To provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties. Setting The meeting was held in Amsterdam, the Netherlands. Methods A panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the “Amsterdam Delphi Method” was utilized including controlled acquisition of feedback, aggregation of responses and iteration. Results Recommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized. Conclusion This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.
Bibliography:	ObjectType-Article-1 ObjectType-News-3 ObjectType-Instructional Material/Guideline-2 SourceType-Conference Papers & Proceedings-1 ObjectType-Conference-4 ObjectType-Feature-5 content type line 25
ISSN:	1550-7289 1878-7533
DOI:	10.1016/j.soard.2017.03.022